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Medicaid expansion in Maine, Arizona provide case studies for Florida

The Senate’s select committee on the Affordable Care Act focused on Medicaid expansion today, listening to advocates on both sides of the debate as well as some touching public testimony.

Early in the meeting, legislators heard from Florida hospital executives who were adamant the state should accept the federal money and expand Medicaid. But the meeting closed with a think tank leader who said two other states' experiences expanding Medicaid years prior outline hidden costs and unexpected issues that make it a bad move for Florida.

Arizona and Maine decided to reduce their uninsured populations well before the Patient Protection and Affordable Care Act became law. Both, according to report from the conservative Foundation for Government Accountability, saw Medicaid spending spiral out of control without any substantial improvements in healthcare or reductions in uninsured people showing up at hospital emergency rooms. The foundation, based in Naples, is run by former Maine legislator Tarren Bragdon.

Mary Mayhew, commissioner of the Maine Department of Health and Human Services, also appeared via Skype, adding onto Bragdon's report with numbers of her own that, she said, showed how disastrous Maine's attempt to expand healthcare coverage had been. Mayhew is an appointee of Republican Gov. Paul LePage, who has already said the state will not accept the federal dollars to further expand Medicaid under the Affordable Care Act.

But is Maine a good litmus test for Florida?

Some health care advocates came away from the meeting arguing “no.” Florida CHAIN, a health advocacy nonprofit group, tweeted that the arguments against Medicaid expansion were “selective, skewed, and irrelevant.”

Linda Quick, president of the South Florida Hospital and Healthcare Association, listened to the meeting remotely and later expressed concern that the two states were “apples and oranges.”

“My hospitals see more Medicaid patients in a day than Maine sees in a year,” said Quick, whose association represents about 40 hospitals in a four-county area. She said Miami’s Jackson Memorial Hospital may actually have more daily Medicaid business than Maine has in several weeks' time.

For the record, Maine has about 358,000 Medicaid patients compared to Florida’s 3.4 million, according to the Kaiser Family Foundation. There are 1.3 million people in all of Maine.

Sen. Joe Negron, the Stuart Republican who chairs the Senate PPACA committee, said there was value in hearing from Maine’s experts despite the difference in size. All the information the committee is collecting will help members reach a final decision, he said.

“Every piece of data is helpful, and there’s strengths and weaknesses to any comparison that you make,” he said. “So I think you can learn from every situation. And I think Arizona is a state that is probably the makeup of the state, demographically, is a lot closer to Florida. And they have some of the same experiences” as Maine.

We reminded him that Arizona Gov. Jan Brewer has announced that she wants her state to further expand Medicaid under the Affordable Care Act.